Bipolar Disorder in Middle Adulthood

Bipolar Disorder bridges the gap between mood disorders and psychotic disorders and is characterised by abnormal moods or exaggerated mood swings.

There are two types of Bipolar Disorder:

Bipolar I Disorder is most closely aligned with the traditional “manic-depression” though lifetime experience of a major depressive episode and psychosis are not requirements for diagnosis.

Bipolar II Disorder, historically considered the “milder” form of the disorder, is characterised by lifetime experience of at least one major depressive episode and one hypomanic episode.

Assessing and Diagnosing Bipolar Disorder

A number of screening tools are available, eg the Bipolar Disorder Self-Assessment Test (Black Dog Institute) which is available as an online tool, and as a Clinician Version to download and print.

For diagnostic purposes however, your psychologist will not rely on screening tools alone and will use your time together to gather information about your symptoms, their onset, severity and duration, and other factors, both historical and current that might impact on your diagnosis.

For a diagnosis of Bipolar I Disorder, a manic episode is the key indicator. Someone experiencing a manic episode might experience:

Elevated (“high”) mood;

Increased energy;

Racing thoughts;

Irritability;

Inflated self-esteem;

Distractibility;

Decreased need for sleep;

Increased goal-directed activity;

Increased risk-taking.

The presence of hypomanic episodes (less extreme “highs”) and depressive episodes is also common in Bipolar I Disorder but not required for diagnosis.

People with Bipolar II Disorder commonly experience hypomania and depressive episodes. Between extreme moods, they might have times where their mood is relatively stable.

Specific Issues in Middle Adulthood

There are no diagnostic specifiers or considerations particular to middle adulthood, however research indicates an increase in depressive symptoms for women with Bipolar Disorder during menopausal transition. Further, a number of the medications used to treat Bipolar Disorder have an impact on physiological outcomes (eg bone density).

Given pharmacotherapy is relied upon in the treatment of Bipolar Disorder, menopause may compound the physiological impacts of medication as well as the associated fluctuations in mood.

Treatment for Bipolar Disorder

Historically, psychotherapy was not considered relevant in the treatment of Bipolar Disorder as it was considered a largely biological condition. However there is now evidence that a number of psychological interventions may be effective in the treatment of Bipolar as an adjunct to psychopharmacological treatment. Note most available research into treatment for Bipolar Disorder does not distinguish between Bipolar I and Bipolar II.

Psychopharmacology

Mood stabilisers (eg Lithium) are used as a primary treatment, supplemented by antidepressant and anti-anxiety medications to provide acute care during mood episodes and encourage long-term mood stability.

Psychotherapy

Cognitive Behaviour Therapy, Interpersonal Therapy, Family Therapy, Mindfulness-based Cognitive Therapy, and Psychoeducation all have Level II evidence (at least one properly designed randomised controlled trial) for the treatment of Bipolar Disorder. Many of these interventions share key elements, which has made evaluating their individual role more difficult. The common shared themes are:

Education about bipolar disorder;

Regularising daily activities;

Reducing substance misuse;

Enhancing medication adherence;

Identifying and managing early warning signs of relapse.

A Wellbeing Plan (similar to a relapse prevention plan) is highlighted as a particularly important treatment component and can include:

Coping with stressful situations;

Lifestyle changes;

Regular routine;

Early warning signs – and what to do when they appear;

Triggers – how to avoid them or minimise their impact;

Medication compliance.

Bipolar Disorder and Menopause

For women experiencing the menopausal transition, learning about, preparing for and/or accepting the significant physiological and associated emotional changes they are likely to experience may be a key component of treatment. This may be of even greater importance for women whose prescribed medication requires review and/or change as a result of the impact of side effects during the transitional period. Your psychologist can discuss the impact of all of these changes and develop strategies with you to manage the transition as part of your treatment plan.

Appointments

Are you looking for a Brisbane Psychologist with Appointments Available Now? Vision Psychology at Mt Gravatt on Brisbane’s southside is open 7 days a week. Appointments with our Brisbane psychologists are available from 8am to 8pm; including Saturday and Sunday.

Freecall 1800 877 924 or 3088 5422. Our friendly staff will assist with bookings or your enquiries. Our reception hours are usually 9am to 8pm Monday to Friday, and 9am to 4pm Saturday and Sunday. Call Centre Managers can be texted on 0431 009 934. At times our phones get very busy, so you can always send a message via our Contact Form.